LVSIG
2005
National
Evaluation
Report
LVSIG
Low Vision Services Implementation Group
Low Vision National Evaluation Report
Research conducted by:
Andrew Gibson
Research Fellow
Institute of Health
School of Health and Social Studies
University of Warwick
Professor Gillian Hundt
Co-Director Institute of Health
School of Health and Social Studies
University of Warwick
Dr Maria Stuttaford
Lecturer in Human Geography
School of Geography and Geosciences
University of St Andrews
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Contents
1.0 Background to the Report . . . . . . . . . . . . . . . . . . . . 5
1.1 Social Policy Context . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.0 Aims of the Evaluation. . . . . . . . . . . . . . . . . . . . . . . 8
3.0
3.1
3.2
3.3
3.4
Evaluation Design . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Document Review . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
In-Depth Study of Three Regions . . . . . . . . . . . . . . . . 9
4.0
4.1
4.2
4.3
4.4
Findings of the Evaluation . . . . . . . . . . . . . . . . . . . 10
Structure and Functioning of the Committees . . . . . . 10
Service User Involvement . . . . . . . . . . . . . . . . . . . . . 11
Promoting Multi-agency Working . . . . . . . . . . . . . . . 14
Improving Services. . . . . . . . . . . . . . . . . . . . . . . . . . 20
5.0 Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . 22
6.0
6.1
6.2
6.3
6.4
6.5
Summary of Recommendations . . . . . . . . . . . . . . 22
Promoting Communication and Good Practice . . . . . 22
Service User Involvement. . . . . . . . . . . . . . . . . . . . . 22
Dealing with Specialist Needs. . . . . . . . . . . . . . . . . . 23
Multi-agency Working . . . . . . . . . . . . . . . . . . . . . . . . 23
Improving Services. . . . . . . . . . . . . . . . . . . . . . . . . . 24
7.0 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Appendix A – Sample Questionnaire. . . . . . . . . . . . . . 25
Appendix B – Information Resources . . . . . . . . . . . . . 37
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1.0
Background to the Report
Previous research has indicated that low vision services in
the UK are fragmented, difficult to access and not meeting
people’s needs (Culham and Ryan 1999, 2002). This
research provided evidence to support the concerns of
many people working in the field of low vision about both
the quantity and quality of services. In particular UK
services appeared to be lagging behind European and
North American agencies in their commitment to integrated
and user centred services.
In response to this growing concern a ‘Consensus
Conference’ was held, chaired by Lord Jenkin in March
1998. Both professionals and service users had the
opportunity to share problems, suggest solutions and
discuss various aspects of low vision practice. Following
the conference, a working group was appointed: The Low
Vision Services Consensus Group. It was given the task of
producing, within a year, a set of recommendations. The
group was made up of representatives of service users,
professionals, voluntary organisations, statutory services
and the Department of Health.
The Low Vision Services Consensus Group reported in
1999. It confirmed the conclusions of previous research
and identified specific problems as the:
●
●
●
●
●
●
Fragmentation of services
Lack of multi-disciplinary and multi-professional working
Inadequate communication between those providing
services
Wide disparity in the quantity and quality of services
between different parts of the country
Lack of information for those who would benefit from the
services
Lack of UK–based research about effective interventions.
To address these problems the report set out a definition of
common standards and services and recommended that
these standards be implemented through the creation of
local Low Vision Services Committees (LVSCs). Although
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not prescriptive, the intention was that the Committees
would take the standards and use them as a basis to create
low vision services that would meet the needs of people
with low vision. To achieve real service effectiveness, it was
a particular concern of the Consensus Group that users
should be consulted and involved in setting them up as well
as in decisions about their subsequent development.
As a result of these recommendations a national steering
group was set up to oversee the development of a network
of LVSCs. This was in effect the successor of the Low
Vision Services Consensus Group. The national steering
group has 35 members made up of representatives of
service users, professionals, voluntary organisations,
statutory services and the Department of Health and meets
quarterly. In September 2000 the steering group appointed
an Implementation Officer (Mary Bairstow) to facilitate the
setting up of the LVSCs and to provide advice to existing
Committees on funding, appropriate membership and
activities. She was also to co-ordinate the production of a
national newsletter and organise an annual conference.
The project was initially funded by Department of Health
Section 64 funding with co-funding contributions from the
RNIB, Guide Dogs for the Blind and Action for Blind
People. However, since September 2003 it has been solely
funded by a wider group of charities that include Age
Concern and the Macular Disease Society.
As of December 2004, 66 Low Vision Services Committees
have been set up across England. All of these have service
user representation and aim to bring together health, social
care, education and other relevant voluntary sector groups.
They aim to:
●
●
●
provide integrated services
inform people about the services and involve them in the
planning
evaluate and monitor the standard of service provided.
The groups generally meet on a quarterly basis. The size of
the groups varies considerably from as low as 8 members
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to over 30. However, responses from the survey carried out
for this evaluation indicate that a regular attendance of
around 10 people is typical, of which 2 are usually service
users. The groups have no income and each group has to
self fund its activities.
1.1 Social Policy Context
The period since the setting up of the project has been one
of considerable change, particularly in health care. Since
April 2002 Primary Care Trusts (PCTs) have taken control
of local health care, while 28 new Strategic Health
Authorities now monitor performance and standards. These
changes and the subsequent impact on service delivery
and funding are something that both staff within the NHS
and LVSCs have had to grapple with. The new PCTs have
undoubtedly been faced with a large number of issues
competing for their attention. The short term effect of this
may have been to make it more difficult for LVSCs to raise
the profile of low vision services within primary care.
However, the national steering group for the Project has
taken steps to secure the commitment of PCTs to support
their local LVSCs.
The Department of Health has recently set up its own
National Eye Care Services Steering Group. This includes
representation from service users in the form of two people
from the RNIB and one from Vision 2020. The Group
published its first report in May 2004, which included a
number of recommendations relating to service delivery,
funding, regulatory issues and key outcomes. It also outlined
proposals for new eye care pathways for the most common
eye conditions – glaucoma, cataract, age related macular
degeneration and low vision, for implementation following a
pilot stage. The aims of the pathways are to provide a user
centred service with reductions in the number of stages
service users have to pass through in order to access
services. Funding has been provided to enable the pathways
to be piloted and evaluated over a two year period. Of the
eight pilot sites, four are piloting the low vision pathway.
After this PCTs of the pilot sites have committed to pick up
the funding for these pilots if they have been shown to be
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successful. Currently LVSCs are actively involved in the
implementation of three of these four low vision pilots.
2.0
Aims of the Evaluation
The main aim of the evaluation has been to make an
assessment of how much progress has been made since
the launch in 1999 of the report of the Low Vision Services
Consensus Group. In particular the evaluation has focused
on:
●
●
●
the role and activities of the LVSC in terms of the
development of new services
the improvement of current services
the role of service users and the development of joint
working.
However, the evaluation has not only focused on outcomes,
but also on the process of developing LVSCs within a
changing environment of health and social care provision.
The evaluation has therefore aimed also to identify from the
LVSCs the
●
●
●
3.0
factors facilitating their successful functioning
barriers and constraints encountered
strengths and areas for improvement.
Evaluation Design
The evaluation involved the use of multiple methods to
access a variety of sources of information. These were as
follows:
3.1 Document Review
●
●
Analysis of policy documents.
Analysis of minutes of meetings of the Steering Group
and of selected LVSCs.
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3.2 Interviews
●
●
Group interview with the members of the Steering Group.
Individual interview with the Implementation Officer.
3.3 Questionnaire
A questionnaire was designed with the Implementation
Officer to collect information on the membership and
activities of the LVSC, a copy of which is attached at
Appendix 1. It was sent out to all 60 of the then existing
committees. 37 surveys were returned, representing a 61%
response rate. This is good for a postal survey.
3.4 In–Depth Study of Three Regions
Three regions were selected for in-depth study – the West
Midlands, London and the South West. These areas were
selected because it was felt that they would provide a
sufficiently broad picture of the experiences and work of the
LVSCs.
In each of the three regions, two workshops were set up
and facilitated using participatory techniques such as
diagramming and visualisation to allow for reflection on the
process and outcomes of the LVSCs. The workshops
aimed to promote dialogue between different LVSCs and
the different groups within them. The Implementation
Officer was involved in planning and running these. In total
6 regional workshops took place. On average eight people
attended each workshop, representing a broad range of the
people involved in the LVSCs. Where appropriate these
regional workshops have been followed up by individual
and group interviews.
An additional workshop with the newly-formed national
sub–committee for children and young people with low
vision was held.
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4.0
Findings of the Evaluation
The evaluation has raised a number of issues, regarding
both the strengths and weaknesses of the project and
possible areas for improvement. These are discussed
below and recommendations made as appropriate. Work
on implementing some of these has already begun.
4.1 Structure and Functioning of the Committees
The project publishes a quarterly newsletter, “Bold View”,
and organises an annual conference. However, the main
link between the Steering Group and the LVSCs is the
Implementation Officer. She has been involved in both the
setting up of committees and in providing ongoing support.
As a result she has good links with a number of the
committees.
There is general acknowledgement that the Implementation
Officer has played a key role in developing the LVSCs.
Without her work it is doubtful that the committee structure
would have developed as rapidly as it has. However, it is
also clear that as the number of committees has grown, it
has become increasingly difficult for one person to
co-ordinate and remain in contact with the LVSCs. These
difficulties are compounded by the fact that information
received by local LVSCs from the Implementation Officer is
not always circulated to the wider membership; for example,
the questionnaire responses indicate that only 22% of
committees distribute “Bold View” to their members.
During the regional workshops it became clear that some
LVSCs lack clarity about their purpose (despite the clear
remit given in the 1999 Report). Others feel isolated, or
they lack the knowledge to access funding or to effect
change. Some committees have attempted to deal with
these problems by developing links with neighbouring
committees, for example regularly exchanging minutes of
meetings.
However, overall there appears to be a need to develop
mechanisms that facilitate better communication between
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LVSCs. This will allow LVSCs that are facing difficulties to
benefit from the good practice and experience of the more
successful committees and help create a stronger sense of
community and of a national network of LVSCs. The
importance of developing mechanisms to allow this to happen
is further highlighted by the fact that the Implementation
Officer’s post is currently funded only until September 2005.
It is therefore important that LVSCs are able to turn to one
another when looking for support to deal with a problem.
Increasing communication and sharing of good practice
could be achieved in a number of ways:
●
●
●
The setting up of a LVSCs website with appropriate news
and information e.g. papers, useful articles and
information on funding opportunities. The site could also
provide an important discussion forum for the LVSCs.
The twinning of LVSCs to facilitate communication and
the sharing of good practice.
The holding of annual regional events or workshops to
bring together members of different LVSCs to share
experiences and exchange ideas.
4.2 Service User Involvement
One of the key aims set out for the LVSCs was to promote
service user involvement. All the LVSCs have members
who are service users and there is evidence that they have
been successful in promoting interest amongst service
providers in the needs of people with low vision. A
frequently reported strength of the LVSCs is the opportunity
that they provide to work jointly with service users and
different service providers to plan and develop services.
The survey results indicate that 71% of LVSCs feel able
either to agree, or strongly agree with the view that their
local committee has improved service user involvement in
the services they receive. Discussions at regional workshops
also indicate that service users bring home the ‘reality’ of
low vision services to local service providers. This can
influence professional thinking about service delivery and
help identify problems not previously recognised as such
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by service providers. However, LVSCs can act as a vehicle
to express service users’ views only if they, themselves
have strong service user involvement. The survey therefore
asked LVSCs to indicate what methods they have used to
improve service user involvement in their work. Some of
the most frequent include:
●
●
●
●
Ensuring that information is passed on to service users in
an accessible format (81%)
Developing links with local service user groups (78%)
Involving service users in the mapping of services (78%)
Involving service users in planning local services (68%).
Despite this, discussions in the regional workshops
indicated that the models of user involvement employed in
the LVSCs differ widely. Within some LVSCs service users
appear to have played a quite passive role, others have
developed a model of shared decision making between
service users and professionals, while a number have
developed a more service user driven approach.
A lack of active service user involvement can also be
compounded by the fact that many service users do not
know what they can expect from service providers, have
low expectations of these services and lack the confidence
to challenge service providers. Again some LVSCs have
attempted to deal with this problem. Suggestions included
developing:
●
●
●
a pack of information to raise service users’ awareness
and expectations of service provision
an induction pack that provides guidance on the role of
service users in LVSCs
a service user sub-group that allows service users to
debate and clarify issues before meeting with
professionals in the main LVSC.
The last approach has a number of advantages. Not only
does it provide peer support and put service users in a
better position to question service providers, it can also
facilitate the involvement of a wider group of service users,
not all of whom may attend the main LVSC. It can therefore
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help to ensure that the views expressed in the main
committee are representative of a wider range of opinions.
The sub-group can also develop methods of consulting
more widely with service users outside the LVSC.
The above difficulties are further compounded by the fact
that the term “low vision” covers a very broad range of
people and problems. The LVSCs have, perhaps
understandably, tended to focus on the needs of adults.
This has resulted, in some cases, in the relative neglect of
the specialist needs of younger people. Similar comments
could be made about the needs of people with multiple
impairments and those from ethnic minorities, who may
have very specific service requirements.
For example, the onset of sight loss raises specific practical
and psychological problems for those who have already
experienced some form of sensory impairment, such as
hearing loss. However, only 27% of LVSCs felt able to
agree or strongly agree that they had been able to improve
services for people with specific specialist needs. In some
instances service users themselves are not appreciative of
the needs of people with special needs or from ethnic
minority backgrounds. Managing these potential conflicts
and arriving at a consensus can be difficult. It is important,
however, that the LVSCs represent as wide a group of
service users as possible. Some LVSCs have dealt with
these problems in a number of ways; for example
Kensington and Chelsea and Westminster have developed
sub–groups to deal with specific issues. These are:
●
●
●
●
Children’s services
Equipment and Training
Referrals and Assessment
Emotional Support.
Each sub-group meets 4 times a year and has developed a
work plan. Each sub-group feeds back to the main LVSC
and the achievements of each group are reviewed annually.
Members of the sub-groups are not drawn solely from the
main LVSC, but are co-opted from a much wider network of
people.
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Other suggestions include:
Actively inviting people to join who have an interest in a
specific issue.
● Having a key person to deal with specific issues.
● Creating a slot on the agenda to address specific needs,
for example children’s issues.
●
There is, therefore, scope to build on the progress already
made to further to improve service user involvement. The
type of solutions discussed above could be facilitated
nationally by the setting up of national sub-committees to
develop guidance on specific issues, along the lines of the
newly created sub-committee for children and young
people with low vision. These could look at issues such as
developing a service user involvement strategy or providing
advice on working with PCTs and may be temporary or
permanent as required. The guidance produced would
supplement that already given to the LVSCs by the 1999
Report of the Low Vision Services Consensus Group and
could be further developed over time as necessary.
Overall a key strength of the LVSCs in relation to the NHS
and Social Services is the potential that they have
demonstrated to provide an effective mechanism via which
these agencies can consult with this group of service users
and service users can bring positive pressure to bear on
service providers. In this respect it is worth noting that
LVSCs are actively involved in the implementation of 3 out
of the 4 new Low Vision Eye Care Pathway Pilot Schemes.
Members of the Merton and Sutton LVSC report that one of
the main advantages of LVSC involvement in their pilot has
been that they provide a ready made forum which brings
together service users, statutory services and the voluntary
sector. This is something that might otherwise have taken
considerable time and effort to organise.
4.3 Promoting Multi–agency Working
The LVSCs operate within widely differing environments
and have therefore to confront very different problems
when promoting multi-agency working. For example, in
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London, PCTs and Social Services Departments are
co-terminous, which contrasts with Shire Counties where
one social service department may deal with half a dozen
PCTs. In these circumstances, it is possible for one LVSC
to encounter widely differing levels of commitment to
improving low vision services from the different PCTs within
its area. Furthermore in some areas there has been little or
no previous tradition of multi-agency working in low vision
services. The problems faced by different LVSCs in getting
social service departments, PCTs and the independent
sector to work together may therefore differ greatly.
Discussions at regional workshops have also highlighted a
number of common barriers to multi-disciplinary working.
These include:
●
●
●
●
●
●
●
●
●
●
●
Postcode variability
Poor awareness of voluntary sector provision within
hospital based services
Poor awareness of rehabilitation and community
provisionwithin hospital based services
Poor communication between services
Difficulty of changing ingrained ways of working among
professional groups
Professions may only work within their own disciplines
Overlapping service provision or demarcation problems
Conflicting definitions of ‘need’ and ‘risk’ between services
Difficulties in changing or modifying working practices
Funding issues
Too many separate departments with their own agendas.
Despite these problems there is a general acknowledgement
of the keenness of people involved with the LVSCs to
improve low vision services. Discussions in regional
workshops highlighted the role that LVSCs can have in
developing new networks, providing a regular meeting point
for different professionals and undermining ‘inter-institutional
suspicion’. Members of LVSCs report that they provide an
important forum for promoting multi-disciplinary working.
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As one interviewee put it:
“The biggest success of LVSCs is that
they are making people talk to each other.”
This comment is supported by the survey results. 78% of
respondents agree or strongly agree that they have good
working relationships with local service providers, while
70% agree or strongly agree that they have been able to
work with service providers to improve low vision services.
A majority of committees responding to the survey indicate
that they are actively working with one or more of the
following service providers:
●
●
●
●
●
Social Services (92%)
PCTs (70%)
Hospital Services (86%)
The Voluntary Sector (70%)
Education Services (51%).
Most frequently this is in the role of joint planning of services
(84%) or as representatives of service users (78%). The
final question in the survey asks people to list 3 strengths
and 3 areas for improvement in their LVSC. The most
commonly reported strength relates to the range of expertise
brought together by the committees, the networking
opportunities created, and the ability to work jointly with
service users to plan services.
Interestingly the most frequently listed area for
improvement is also the need to improve both service user
and service provider involvement. This perhaps reflects
both an acknowledgement of what has been achieved and
recognition of the work that still needs to be done.
It is also interesting to note that the LVSCs report a
significantly higher level of active involvement from social
services (92%) as opposed to any other service provider.
This discrepancy was also picked up at regional workshops.
There may be a number of reasons for this. However, one
issue may be that the Association of Directors of Social
Services produced a report, “Progress in sight” (October
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2002) which sets out 16 national standards of social care
for adults with visual impairments and a recommendation
to set up a “local planning committee of service users and
representatives from a wide range of local agencies to
co-ordinate low vision services.” (p. 20). Members of
LVSCs frequently expressed a feeling that PCTs had yet
to give adequate emphasis to low vision services.
Despite these difficulties, progress has been made. As one
interviewee put it:
“I do think because of the inception of the
LVSCs the words ‘Low Vision’ are more
prominent than they’ve been previously or
would have been previously, if the
committees hadn’t been there, and I do
think that that’s a step forward.”
Examples of how LVSCs have acted as an important
vehicle to promote multi-disciplinary working and better
communication between service providers and a conduit for
sharing knowledge include:
●
●
●
Service providers giving presentations on their services.
Organisations giving clarification on their procedures, e.g.
the registration process.
Providing an opportunity to examine different agencies’
roles and the problems they face when attempting to
meet service users’ needs.
All of the above give members of LVSCs a better
understanding of the constraints within which various
service providers operate and the obstacles that have to be
overcome if low vision services are to be improved.
Developing a clearer understanding of the differing roles
that people play is essential if the LVSC is to make best
use of the skills and knowledge of its members.
However, managing the potentially conflicting groups within
a LVSC can be very difficult. Ensuring that service users
are adequately involved, especially where the format of the
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meeting might require special modifications to ensure this
happens, or promoting multi-disciplinary working where
service providers come to meetings with different
expectations, styles, traditions and language, can be very
demanding. Dealing with potential conflicts, both between
service users and providers and also between different
service providers and different groups of service users, can
also be very difficult. In these circumstances achieving
consensus and implementing a plan of action is easier said
than done.
The role of the chair of the LVSC can be vital in this. Key to
this appears to be the establishment of a shared language
and aims. However, these pressures can lead to some LVSC
chairs feeling isolated and demotivated.
Possible ways of dealing with these problems include
developing a network of LVSC chairs. This would facilitate
the sharing of experience and good practice and could act
as a forum for discussing new ideas. A chairs’ forum could
be included as a feature of an LVSC website. The
development of a pack of information which provides
guidance on the role of chairs in LVSCs, would be useful.
Although creating opportunities for sharing information and
networking are an important benefit of LVSCs, these are
not ends in themselves. One of the fears voiced at the
commencement of the project was that the committees
might degenerate into ‘talking shops’. The evaluation has
indicated that this is a potential danger, particularly where,
through lack or funding or influence, LVSCs are not able to
implement the changes they would like.
However, the questionnaire responses suggest that this
has not happened in the majority of cases. 79% of LVSCs
agree or strongly agree that their LVSC has been able to
promote the development of services to meet local need,
while 70% of committees either agree or strongly agree
that they have been able to work with service providers to
improve low vision services. In many cases these service
improvements may not be on a large scale as we shall see
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later in this section, but can often have an important impact
on the quality of service users’ experiences.
Working to improve services, however, does not
automatically result in improvements for service users.
While 70% of LVSCs indicate that they have been involved
in improving the dissemination of information about local
services to the community, only 55% of LVSCs either agree
or strongly agree that they have actually been able to
improve communication with service users about the services
they receive. Part of the problem appears to be that LVSCs
can spend a lot of time working on a project only to find
that service providers locally do not take it up. This is
related to the fact that many LVSCs experience significant
difficulty in getting the appropriate level of involvement from
service providers, particularly at commissioning level.
The final question in the survey asks people to list 3 areas
for improvement in their LVSC. One of the most commonly
reported weaknesses relates to accessing funding and
putting plans into action. 76% of LVSCs report that
accessing funding is the main barrier to improving services.
46% indicated that influencing the planning process is a
major problem when attempting to improve services and
41% reported that implementing a joint plan of action with
service providers is another. These difficulties can lead to
feelings of frustration and disillusionment in some LVSCs,
as the hoped for progress is not achieved, despite the good
intentions of those involved. It is when this happens that
LVSCs are most likely to degenerate into ‘talking shops’.
This state of affairs is also damaging to service user
involvement, particularly if the LVSC is seen to be engaged
in endless consultations, but unable to bring about the
desired changes in services.
However, there is also evidence that some LVSCs have
been more successful than others in engaging key
stakeholders. 24% of LVSCs report that they have been
able to access funding via PCTs and 30% indicate that they
have been able to do this via Social Services Departments.
While these figures are low they demonstrate that there is
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the potential for other LVSCs to learn from these
experiences. Some LVSCs have attempted to deal with
these problems in the following ways:
●
●
Ensuring that proposals have multi agency involvement,
thus making them harder to ignore
Developing clearer reporting pathways to relevant
organisations in an effort to raise the profile of the LVSC
and improve communication.
It is important that the work of the LVSCs is reported back
to the organisations that are represented on the committee.
The regional workshop discussions indicate that many of
the LVSCs lack any clear routes for reporting their work.
Developing clearer reporting structures to local service
providers will help raise both the profile of low vision services
and increase the impact of the work of the LVSC locally
with service providers. Often the ability to engage with key
stakeholders is facilitated by the presence of a key
individual who is in a position to act as a catalyst to bring
about change. However, this is only likely to be successful
if it is met with a positive response from service providers,
something that, as we have seen, is not always forthcoming.
4.4 Improving Services
When evaluating this aspect of the work of LVSCs it is
important to bear in mind that LVSCs do not have any
funding of their own, administrative support or means by
which to force improvements in services. They can merely
identify problems and advise/lobby service providers on what
needs to be done to improve low vision services. Despite
these limitations, the evidence collected for the evaluation
indicates that LVSCs have been involved in improving
services in a wide range of ways. These improvements
need not be on a large scale. For example, one LVSC was
able to ensure that all local GPs sent out letters about the
flu vaccination this winter in point 14 font. The survey
indicates that the following are common examples of service
improvements:
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Improving the dissemination of information about local
services to the community (70%)
● Working on the new integrated registration system (Letter
of Vision Impairment/Certificate of Vision Impairment)
(70%)
● Developing links with optometrists based in primary care
(65%).
These types of changes can be important to improving the
quality of the services that people use, but what of the
large scale changes that might be required to bring about
the sort of ‘gold-standard’ comprehensive services, aimed
for in the Low Vision Report?
●
In this particular area funding has obviously been a key
issue for the LVSCs. 76% of LVSCs report that this has
been the main difficulty they face in improving services.
Bringing people and money together at the right time and
place can be a difficult task. However, some committees
appear to be more advanced than others in their knowledge
of the potential sources of funding and understanding of
how to access them. One of the main potential sources of
such funding is from local PCTs. However, lack of knowledge
about the bidding process or how to input into PCT local
development plans can result in LVSCs missing out. Only
24% of LVSCs have indicated that they have been able to
access funding from this source. This is more likely to
happen where PCTs or Strategic Health Authorities are not
represented on the LVSC. However, there are examples of
PCTs and LVSCs working together to access money to
fund new services.
Again there is the opportunity for LVSCs to learn from one
another. Merton and Sutton LVSC report that being able to
access funding via one of the National Eye Care Services
Steering Group Pilot Projects has helped rejuvenate their
group. However, it is evident that guidance needs to be
made available to LVSCs on how to access various
sources of funding. For example LVSCs need to have a
better understanding of PCT funding procedures and ways
of working. Nationally produced documents that assist in
this process will help both LVSCs and PCTs in promoting
low vision services.
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5.0
Concluding Remarks
There is evidence that the LVSCs have made significant
progress since their inception in 1999. They face a number
of significant challenges, not least of which is engaging
with key stakeholders such as PCTs and widening their
base of service user involvement. Nevertheless the
evidence collected for this evaluation suggests that a key
strength of the LVSCs is the potential that they have to
provide a mechanism via which consultations with service
users can take place and through which service providers
can develop links with one another. However, a significant
commitment from local and national statutory services is
also needed if this progress is to be continued.
6.0
Summary of Recommendations
A summary of the recommendations in this report is given
below.
6.1 Promoting Communication and Good Practice
To improve communication in the sharing of good practice
we suggest:
●
●
●
The setting up of a LVSCs website with appropriate news
and information e.g. papers, useful articles and
information on funding opportunities. The site could also
provide an important discussion forum for the LVSCs
The twinning of LVSCs to facilitate communication and
the sharing of good practice
The holding of annual regional events or workshops to
bring together members of different LVSCs to share
experiences and exchange ideas.
6.2 Service User Involvement
To further promote service user involvement we suggest:
●
The development of a pack of information to raise service
users’ awareness and expectations of service provision
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●
●
The development of an induction pack that provides
guidance on the role of service users in LVSCs
The use of service user sub-groups that allow service
users to debate and clarify issues before meeting with
professionals in the main LVSC.
6.3 Dealing with Specialist Needs
LVSCs should be encouraged to develop appropriate
strategies aimed at meeting the needs of groups with
specialist needs. These strategies could include:
●
●
●
●
Actively inviting people to join who have an interest in a
specific issue
Having a key person to deal with specific issues
Creating a slot on the agenda to address specific needs,
for example children’s issues
Creating a sub-group to deal with a specific issue.
The development of these strategies could be facilitated
nationally by the setting up of national sub–committees to
develop guidance on specific issues, along the lines of the
newly created sub–committee for children and young
people with low vision and may be temporary or permanent
as required.
6.4 Multi–agency Working
One of the key strengths of LVSCs is their ability to bring
service users and different service providers together.
However, we suggest that this process could be further
facilitated by
●
●
●
Developing a network of LVSC chairs’. This would
facilitate the sharing of experience and good practice and
could act as a forum for discussing new ideas. A chair’s
forum could be included as a feature of a LVSC website
The development of a pack of information which provides
guidance on the role of chairs in LVSCs
Guidance on developing clearer reporting pathways to
relevant organisations in an effort to raise the profile of
the LVSC and improve communication.
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6.5 Improving Services
A major barrier to progress in this area is accessing
funding. We therefore suggest that guidance be made
available to LVSCs on how to access various sources of
funding. This guidance could include information on:
●
●
PCT funding procedures and local development plans
Developing multi-agency service proposals.
Nationally produced guidelines that assist in this process
will help both LVSCs and service providers in promoting
low vision services.
Acknowledgements
We would like to thank Mary Bairstow and Christine Dale
for their invaluable assistance in carrying out the
evaluation. We would also like to thank the members of the
LVSCs who gave their time and knowledge.
7.0
References
ADSS (2002) “Progress in sight”, Disabilities Committee,
ADSS, London.
Culham, L.E., Ryan, B., Jackson, A.J., Hill, A.R., Jones, B.,
Miles, C., Young, J.A., Bunce, C., and Bird, A.C. “Low
vision services for vision rehabilitation in the United
Kingdom”, BJO 2002, 86(7).
Culham, L.E., Ryan, B. (1999) “Fragmented Vision –
Survey of low vision services in the UK” RNIB, London.
Low Vision Services Consensus Group (1999) “Low Vision
Services: Recommendations for future service delivery in
the UK” RNIB, London.
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Appendix A – Sample Questionnaire
Low Vision Services Committee Survey
The following questions have been designed to learn from
you about the roles and activities of the Low Vision
Services Committees throughout England. The results will
be fed back to you in order for you to continue to improve
services for people with low vision. Your responses will be
kept anonymous.
Please provide written comments or tick the relevant boxes
as appropriate.
Name of Committee:
Section A: General Information
In this section we ask you some questions about the history
and background of your committee.
1. How long has your Committee existed?
2. How many times a year does it meet?
3. Do you think it should meet more often? If yes, how
often?
4. Do you think it should meet less often? If yes, how
often?
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5. How many people are on your Committee?
6. How many Committee Members attend regularly i.e.
more than 50% of the meetings?
7. How many Committee Members are service users?
8. How many service users attend regularly i.e. more than
50% of the meetings?
9. Do you think the membership should be in any way
different? If yes, in what way?
10. How many Committee Members attended the last Low
Vision Conference held in Sheffield in May 2004?
11. Do you distribute the national newsletter to your
Committee Members?
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Section B: Improving Service User Involvement
In this section we ask you about involving people who have
a visual impairment and people who use low vision services
in your work.
1. Has your committee been able to improve service user
involvement in any of the following ways? (tick all that apply)
A) Developing links with local service user groups . . . . . ■
B) Developing links with national service user groups . . . ■
C) Increasing service user representation on the
committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
D) Improving representation from service users with
specialist needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Inviting people form local groups to speak at your
committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
F) Providing support to invited speakers . . . . . . . . . . . . . ■
G) Organising consultation workshops with groups of
service users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
H) Involving service users in mapping local services . . . . ■
I) Involving service users in planning local services . . . . ■
J) Ensuring that all materials used at meetings are in an
accessible format (e.g. large print) . . . . . . . . . . . . . . . . . ■
K) Other (Please specify) . . . . . . . . . . . . . . . . . . . . . . . . ■
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2. How far would you agree that your committee has
improved service user involvement in the services they
receive
A) Strongly Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
C) Neither Agree nor Disagree . . . . . . . . . . . . . . . . . . . . ■
D) Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Strongly Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
3. Which of the following forms of communication do you
use when passing on information to people with a visual
impairment? (tick all that apply)
A) Large print documents . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Braille . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
C) Tapes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
D) Electronically (e.g. via email or disk) . . . . . . . . . . . . . ■
E) Other (Please specify) . . . . . . . . . . . . . . . . . . . . . . . . ■
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4. How far would you agree that your committee has
improved communication with service users about the
services they receive
A) Strongly Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
C) Neither Agree nor Disagree . . . . . . . . . . . . . . . . . . . . ■
D) Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Strongly Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
Section C: Working with Service Providers
In this section we ask you about your work with organisations
that provide services to people with low vision.
1. Which of the following service providers are represented
on your committee? (tick all that apply)
A) Social Services Department . . . . . . . . . . . . . . . . . . . . ■
B) Primary Care Trust (PCT) . . . . . . . . . . . . . . . . . . . . . ■
C) Hospital Based Services . . . . . . . . . . . . . . . . . . . . . . ■
D) Agencies working with older people (people over 65) . ■
E) Agencies working with young people (people
under 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
F) Education Services . . . . . . . . . . . . . . . . . . . . . . . . . . ■
G) Voluntary Sector (Please specify) . . . . . . . . . . . . . . . ■
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H) Other Service Providers (Please specify) . . . . . . . . . . ■
2. Which of the following service providers is your
committee actively working with? (tick all that apply)
A) Social Services Dept. . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Primary Care Trust . . . . . . . . . . . . . . . . . . . . . . . . . . ■
C) Hospital Based Services . . . . . . . . . . . . . . . . . . . . . . ■
D) Agencies working with older people (over 65) . . . . . . ■
E) Agencies working with young people (under 18) . . . . . ■
F) Education Services . . . . . . . . . . . . . . . . . . . . . . . . . . ■
G) Voluntary Sector (Please specify) . . . . . . . . . . . . . . . ■
H) Other Service Providers (Please specify) . . . . . . . . . . ■
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3. In what ways have you been working with these service
providers? (tick all that apply)
A) As commissioners of services . . . . . . . . . . . . . . . . . . .■
■
B) As joint planners of services . . . . . . . . . . . . . . . . . . . .■
■
C) As representatives of service users . . . . . . . . . . . . . . .■
■
D) Other (Please specify) . . . . . . . . . . . . . . . . . . . . . . . .■
■
4. How far would you agree that your local committee has
established good working relationships with local service
providers
A) Strongly Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
C) Neither Agree nor Disagree . . . . . . . . . . . . . . . . . . . . ■
D) Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Strongly Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
5. How far would you agree that your local committee has
been able to work with service providers to improve low
vision services
A) Strongly Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
C) Neither Agree nor Disagree . . . . . . . . . . . . . . . . . . . . ■
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D) Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Strongly Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
Section D: Improving Services
In this section we ask you about the work of the Committee
to improve services for people with low vision.
1. Has your committee been involved in improving services
in any of the following ways? (tick all that apply)
A) The expansion of an existing service . . . . . . . . . . . . . ■
B) The creation of new services . . . . . . . . . . . . . . . . . . . ■
C) Improvement in the dissemination of information
about the local services to community . . . . . . . . . . . . . . ■
D) The promotion of services for specialist groups,
e.g. people with multiple-impairments or people from
minority ethnic groups? . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Improving co-ordination between health and
social services e.g. via the appointment of a service
co-ordinator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
F) The development of low vision passports (patient–
held records) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
G) Working on the new integrated registration system
(Letter of Vision Impairment/Certificate of Vision
Impairment LVI/CVI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
H) Improving physical accessibility . . . . . . . . . . . . . . . . . ■
I) Developing rehabilitation services . . . . . . . . . . . . . . . . ■
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J) Developing links with optometrists based in primary
care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
K) Developing links with dispensing opticians based in
primary care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
L) Other (Please specify) . . . . . . . . . . . . . . . . . . . . . . . . ■
2. Have you been able to access any of the following
funding sources? (tick all that apply)
A) Primary Care Trusts . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Social Services Departments . . . . . . . . . . . . . . . . . . . ■
C) Lottery Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
D) Voluntary Sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) General Ophthalmic Services Funding . . . . . . . . . . . . ■
F) Other? (Please Specify) . . . . . . . . . . . . . . . . . . . . . . . ■
3. How far would you agree that your committee has
promoted the development of services to meet identified
local needs
A) Strongly Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
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C) Neither Agree nor Disagree . . . . . . . . . . . . . . . . . . . . ■
D) Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Strongly Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
4. Has your group been involved in improving services for
people with specific specialist needs? (tick all that apply)
A) People with multiple impairment . . . . . . . . . . . . . . . . . ■
B) Younger people (people under 18) . . . . . . . . . . . . . . . ■
C) People from ethnic minorities . . . . . . . . . . . . . . . . . . . ■
D) Working people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Older people (people 65 and over) . . . . . . . . . . . . . . . ■
F) People with other sensory impairments . . . . . . . . . . . ■
G) Other (Please specify) . . . . . . . . . . . . . . . . . . . . . . . . ■
5. How far would you agree that your committee has
improved services for people with specific specialist needs
A) Strongly Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Agree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
C) Neither Agree nor Disagree . . . . . . . . . . . . . . . . . . . . ■
D) Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Strongly Disagree . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
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6. What have been the main difficulties you have
encountered in attempting to improve services? (tick all
that apply)
A) Accessing funding . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
B) Influencing the planning of services . . . . . . . . . . . . . . ■
C) Making links with the relevant people/groups . . . . . . . ■
D) Implementing a joint plan of action with other service
providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ■
E) Other (Please specify) . . . . . . . . . . . . . . . . . . . . . . . . ■
What do you think are the three main strengths of the
LVSC of which you are a member?
1.
2.
3.
What do you think are the three main areas for improvement?
1.
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2.
3.
Please use the space below to make any other comments
you would like to make about the work of the LVSC of
which you are a member.
In the next phase of the evaluation, we would like to speak
to Committees in more detail. Are you willing to be contacted
for this purpose? Yes ■ / No ■
Many thanks for taking time to complete this questionnaire.
Please return it by September 30th to Andy Gibson,
Research Fellow, Institute of Health, School of Health and
Social Services, University of Warwick, Coventry, CV4 7AL.
E–mail address: Andrew.J.Gibson@warwick.ac.uk.
If you have any concerns regarding this questionnaire
please contact Andy Gibson at the above address or
telephone 02476 572592 or 02476 523164.
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Appendix B – Information Resources
Website details
Vision 2020 – Including access to the LV Group.
www.vision2020uk.org.uk.
NatPact – direct link to the Optometric Competency on LV.
www.natpact.nhs.uk/newcf/index.php?show=y&d=O&c=14.
More details about NatPact itself. www.natpact.nhs.uk.
Department of Health – with a direct link to Eye Care
Steering Group information.
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCare
Topics/Optical/OpticalDocumentsArticle/fs/en?CONTENT
_ID=4079525&chk=P4YrBm.
Low Vision Specific Texts/reports
Low Vision Services – Recommendations on training in
support of the low vision framework (available from Guide
Dogs).
Current Low Vision Practice 2002 (available from the
LVSIG office).
Framework for a multi–disciplinary approach to low vision
©The College of Optometrists 2001.
Ryan, B., and Culham, L. (1999) Fragmented Vision:
Survey of low vision services in the UK. RNIB & Moorfields
Eye Hospital NHS Trust.
Ryan, B., and McCloughan, L (1999) Our Better Vision:
what people need from low vision services in the UK.
London RNIB. ISBN: 18598782406
Practical aspects of Committee activity
The Bold Guide to setting up and running an LVSC –
available from the LVSIG office.
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RNIB See it right pack 2001.
How to make your information accessible to people with
sight problems.
Visual Impairment, Health and Social Care issues
National Eye Care Services Steering Group – First Report
2003.
Progress in sight: National standards of social care for
visually impaired adults ADSS.
Social Services Inspectorate. A Sharper Focus: inspection
of services for adults who are visually impaired or blind.
CI(98)8. 1998.
Wormald, R.P.L., Wright, L.A., et al. Visual problems in the
elderly population and implications for services. BMJ 1992;
304: 1226 –1229.
National Service Framework for Older People, London
2001, Department of Health.
National Service Framework for Diabetes, London 2001,
Department of Health.
NHS Executive, National Health Service Plan, London 2001.
National Service Framework for Children, Young People
and Maternity Services London 2004, Department of
Health.
Charter for Families of Young Children with Vision
Impairments Oxford Brookes University.
Registered Blind and Partially Sighted People. Year Ending
31 March 2003. England Department of Health.
Early Support Family Pack DFES 2004.
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©
Low Vision Services Implementation Group
RNIB, Borough Buildings, 58-72 John Bright St., Birmingham, B1 1BN
Tel: 0121 665 4248/9 Fax: 0121 665 4254